Sara pulls the woven, green hat from her head to show her nearly bald scalp, with only a few tufts of long, thin hair surrounding her crown. Sara has trichotillomania. She pulls her own hair out.
“This is where I pull from, Dr. Deibler,” she explains. I nod and say nothing, not because it’s unimportant, but because it’s important to react as if this discussion is like any other discussion, even though she has never before revealed her trichotillomania to anyone.
This is not the first time I met with Sara. In fact, we’d been working together for months, but this is the first time she felt comfortable enough to show me what she’s done to herself.
It hadn’t always been this way for Sara. She began pulling her eyelashes and eyebrows at age 7. Now, at age 14, she’s pulled nearly all of the hair from her head and wears a cap so that no one can see. It’s not that she’s never sought help. She’d been to therapist after therapist, each one helping her cope with her parents’ divorce and family problems, but none of whom knew how to help Sara with her hair.
Now, she was working hard in her treatment to develop awareness, build coping skills, and develop new behavior patterns. She and her mother attended our trichotillomania support group to meet others who were struggling. And, over time, Sara improved, not just her pulling, but her happiness, confidence and self-acceptance.
That was two years ago. She doesn’t come by much anymore because she doesn’t need to. She no longer struggles, but she remembers what it was like to struggle. Earlier this year, she spoke to our support group for those who struggle with hair pulling. Many who attended wore head coverings, hairstyles, or makeup to hide their hair loss too, but not Sara. She was able to tell them what trichotillomania was like for her, as she sat in front of them with her long, beautiful, blonde hair and showed them how this struggle can change. In Sara, they saw themselves and they saw hope.
I often tell my patients that aside from treatment itself, an important thing unfolds in recovery: When people stop hiding, they start getting better. And this is what has happened for Sara; she stopped hiding and started living.
Dr. Marla Deibler, Sara’s therapist, will be with us on Therapy Soup for a few posts. Dr. Deibler is the founding director of The Center for Emotional Health of Greater Philadelphia. She specializes in the treatment of anxiety and the obsessive-compulsive disorders spectrum. She is also an expert on tricholtillomania, a hair-pulling disorder.
Welcome, Dr. Deibler. Let’s start with the basics. What is trichotillomania and who has this disorder?
I am very thankful for the opportunity to share information with your readers about this significant problem which is so rarely discussed.
Trichotillomania affects between 2% and 4 % of children and adults, with females affected more overall. Every day in the Unites States, 200 to 400 children and adolescents begin pulling their hair, yet there is little awareness of this problem in mainstream culture. Very frequently, those afflicted with Trichotillomania suffer in shame and silence.
Trichotillomania (trick-o-till-o-MAY-nee-ah; also known as TTM or “trich”) is a disorder which causes individuals to pull out hair from the scalp, eyebrows, eyelashes, or other part(s) of the body, resulting in noticeable hair loss. Individuals who pull their hair typically wish to cease the behavior, but have difficulty doing so without assistance. This disorder is currently classified as an Impulse – Control Disorder; however, it is considered to belong to a family of Body – Focused Repetitive Behaviors (BFRBs), which include behaviors such as skin picking, nail biting, and lip or cheek biting.
The severity of trichotillomania can vary greatly from small areas of thinning hair to the complete absence of eyelashes, eyebrows, and/or scalp hair. Trichotillomania typically causes significant distress and may lead to shame, secrecy, and embarrassment as well as isolation and avoidance of activities due to fears that others will notice the hair loss. As a result, individuals often cover up or hide the behavior and are reluctant to seek treatment.
In addition to emotional distress and avoidance behaviors, trichotillomania has the potential to result in acute medical consequences. For example, those who bite and/or ingest pulled hairs may suffer from gastrointestinal distress or, moreover, intestinal blockage as the result of a trichobezoar (hair ball) which may require surgical intervention to remove the hair and restore digestive functions.
We’ll be posting more about trichotillomania with Dr. Deibler, soon.
You can learn more about trichotillomania from the Center for Emotional Health’s information booklet (PDF) and from the Trichotillomania Learning Center. Dr. Deibler’s web site, her Facebook page, and her YouTube channel, and you can follow her on Twitter.
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Last reviewed: 3 Oct 2013